Neuroscience-Based Relational Art Therapy (RAT) and Deep Brain Reorienting (DBR) in the Treatment of dissociative identity disorder (DID)

Anna Gerge ^*

• Aalborg University, Aalborg, Denmark

Art therapy (AT) has been proposed as a treatment for post-traumatic conditions, potentiallyby providing somatic sensory input that can (i) enhance the client's sense of self andembodiment, (ii) modulate arousal, and (iii) aid in rethinking and reframing traumaticmemories. The evidence base for AT in the treatment of dissociative disorders is sparse. Thetheoretical basis for the efficacy of AT is discussed in relation to findings regarding thetraumatized person's brain and mindset, and its altered functional network connectivity. It isimperative to consider the particular alterations in brain networks associated with trauma,particularly those occurring in the deep brain, which includes the midbrain, the brainstem, and the cerebellum. According to the hypothesis, early and/or severe trauma can adversely affect higher regulatory functions of the brain, which can be elucidated through the cascade theory. This theory delineates how diverse activation patterns within the midbrain's periaqueductal gray (PAG) of the midbrain influence the limbic system and cortices, thereby modulating States of Being and behavior. Phase-specific, resource-oriented, and long-term therapy for complexly traumatized and dissociative individuals can utilize novel insights from neuroimaging studies to inform and enhance therapeutic methods. This is illustrated in aclinical vignette with a client diagnosed with dissociative identity disorder (DID), where deepbrain reorienting (DBR) was combined with relational AT. The AT element is hypothesized to have facilitated a sense of grounding in the present moment and enhanced the client's access to her neurophenomenological self. Also, changes at implicit and non-verbal levels were potentially facilitated. DBR is believed to have enabled the client to remain present with her previously avoided and unbearable internal experience. To validate these assumptions, the second author conducted a semi-structured interview that focused on being dissociative and being in psychotherapy, including experiencing the effect of deep brain reorienting, DBR, when introduced after AT. The client's voice is finally shared through a thematic analysis of the interview, which yielded the following themes: Loneliness, getting help, and moving towards togetherness. Further research on and development of therapy methods that enhance the neuroplasticity necessary for highly dissociative clients to change and heal is desirable.